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A Decade of Robotic Hepatectomies: Learning Curve and Outcomes

Over a 10-year span, a medical center’s experience with 100 major robotic liver resections was examined, showing the evolution of robotic surgery. The study found no significant differences in key parameters like operative time, blood loss, length of hospital stay, 90-day readmission, major complications, and mortality between early and late cases. Notably, the study revealed a learning curve, with improved ICU admission rates and higher difficulty indices in the latter half of the cases. This suggests that developing a successful robotic liver program is achievable over time, with the institutional learning curve stabilizing after approximately 50 cases.

Journal Article by McCarron F, Cochran A (…) Martinie J et 5 al. in Surg Endosc

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Quality of Care in Appendicitis: Regional Hospitals Outperform Tertiary Care Centers

A comparative study of 2,158 adult appendicitis patients in different hospital settings revealed notable differences in surgical outcomes. Patients in tertiary care hospitals experienced longer surgical waiting times, increased surgical delays, longer operation times, higher rates of appendix perforation, and greater hospital costs compared to those in regional hospitals. Factors linked to surgical delays were the hospital type and delayed diagnosis, while postoperative complications were associated with older age, male sex, surgical delay, and appendix perforation. The study suggests the need for an efficient referral system to enhance patient care and reduce medical costs.

Journal Article by Hsiao YW, Hsiao CY (…) Chen PY et 2 al. in World J Surg

© 2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.

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Transverse Coloplasty Pouch Improves Bowel Function After Rectal Cancer Surgery

Researchers compared two surgical techniques for rectal cancer patients who underwent intersphincteric resection (ISR): transverse coloplasty pouch (TCP) and straight coloanal anastomosis (SCAA). While oncological outcomes were similar, the study found that two years after ileostomy closure, the TCP group had significantly less major low anterior resection syndrome (LARS) and better Wexner scores compared to the SCAA group. TCP was identified as an independent factor in preserving postoperative bowel function. This suggests that TCP is a safer choice for reducing bowel dysfunction in low rectal cancer patients after ISR.

Journal Article by Pan H, Zhao Z (…) Huang S et 4 al. in J Gastrointest Surg

© 2023. The Society for Surgery of the Alimentary Tract.

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Routine Visceral Branch Resection in Rectal Cancer Lymph Node Dissection: Safe and Efficient

Researchers investigated the safety and feasibility of a modified lymph node dissection (LLND) in mid-low-lying rectal cancer, involving routine resection of visceral branches of internal iliac vessels. The study compared two groups: one with routine resection (RVR) and one without (NVR). The RVR group saw reduced operative times without a significant difference in postoperative complications or the number of lateral lymph nodes harvested compared to the NVR group. This suggests that LLND with routine visceral branch resection is safe and feasible, offering no major complications or long-term urinary issues.

Journal Article by Xiao J, Zhang X (…) Wang Z et 4 al. in J Surg Oncol

© 2023 Wiley Periodicals LLC.

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Review Finds Combination of Mechanical Devices More Effective for Preventing VTE After Surgery

A systematic review compared the effectiveness of mechanical prophylaxis devices in preventing venous thromboembolism (VTE) during and after surgery. The study included 14 articles and found that intermittent pneumatic compression (IPC) was superior to graduated compression stockings (GCS) when used alone. Additionally, a combination of IPC and GCS showed greater efficacy compared to GCS alone, especially in high-risk patients. While IPC had a better safety profile, compliance was lower. The study suggests further high-quality research is needed, particularly in high-risk surgical settings where pharmacological prophylaxis is not an option.

Review by Herring B, Lowen D, Ho P and Hodgson R in Langenbecks Arch Surg

© 2023. The Author(s).

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Dilation Status Irrelevant in Bile Duct Injury Repairs: Surgical and Radiological Drainages Equally Effective

A retrospective study on 87 patients who underwent hepaticojejunostomy (HJ) for bile duct injuries (BDI) aimed to determine whether the dilation status of the bile duct before repair affected outcomes. The study found that dilation status had no impact on short- or long-term results, including anastomotic stricture rates. Patients without preoperative dilation had more severe BDI injuries and lower rates of preoperative cholangitis. The study suggests that both surgical and radiological external biliary drainages can effectively reduce cholangitis risk without increasing the risk of long-term anastomotic stricture.

Journal Article by Marichez A, Fernandez B (…) Chiche L et 7 al. in Langenbecks Arch Surg

© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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Remote Assessment of Surgical Safety Checklists

Researchers utilized the OR Black Box, a surgical data capture system, to evaluate surgical safety checklist performance across 7 North American academic medical centers. Their analysis of 7,243 surgical procedures revealed that most included a time-out (98.4%) and 62.3% included a debrief. These procedures often involved a majority of OR staff, with team introductions leading to more checklist items completed, higher engagement, and better focus during time-outs. This remote assessment offers valuable insights and the potential to enhance intraoperative processes.

Journal Article by Riley MS, Etheridge J (…) Molina G et 7 al. in J Am Coll Surg

Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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How Condition Timing Impacts Liver Surgery Outcomes

In the realm of liver surgery, understanding the “condition(s) present at time of surgery” (PATOS) from the American College of Surgeons (ACS) database is crucial. Researchers explored postoperative complications, considering PATOS, and found that when these conditions were factored in, complication rates dropped across the board. Their study, covering data from 2015 to 2019, highlights the significance of accounting for PATOS in assessing post-surgery complications in liver patients. This data-driven approach can lead to better-informed surgical decision-making and improved patient outcomes.

Journal Article by Jehan FS, Ganguli S (…) Aziz H et 4 al. in Am J Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Conversion to Open Surgery in Liver Resection: Risks and Consequences

Researchers delved into minimally invasive liver resections (MILR) and what happens when they switch to open procedures. Out of 1,675 patients, 6.1% required a switch due to unfavorable findings or intraoperative issues. Those needing a conversion experienced higher complications, blood loss, and mortality. Intraoperative conversions had even worse outcomes, emphasizing the need for cautious planning and early conversion for high-risk patients. This study warns about the challenges of transitioning from MILR to open surgery, highlighting the associated risks and complexities.

Journal Article by Gudmundsdottir H, Fiorentini G (…) Cleary SP et 14 al. in Surg Endosc

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Surgical Tele-Mentoring Enhances Robotic Surgery

This study explored the impact of surgical tele-mentoring, where remote experts guide local surgeons via robotic technology. They conducted a feasibility study in fields like general, urology, gynecology, and thoracic surgery, with 15 cases. The results were impressive; participants reported enhanced procedural competence, timely interventions, improved surgical efficiency, and better decision-making. Connectivity remained robust with no perceived delays. This technology was deemed safe and valuable, showing great promise in expanding access to surgical expertise during peacetime, wartime, and pandemics.

Journal Article by Faris H, Harfouche C, Bandle J and Wisbach G in Surg Endosc

© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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